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Glomerular disorders are classified as those that manifest predominantly with hematuria (nephritic syndrome), high-level proteinuria (nephrotic syndrome), or both. Disorders tend to manifest at different ages (see Table 1: Glomerular Disorders: Glomerular Disorders by Age and Presentation ) although there is much overlap. The disorders may be primary or have secondary causes (see Table 2: Glomerular Disorders: Causes of Glomerulonephritis and Table 4: Glomerular Disorders: Causes of Nephrotic Syndrome).
The pathophysiology of nephritic and nephrotic disorders differs substantially, but their clinical overlap is considerable—eg, several disorders may manifest with the same clinical picture—and the presence of hematuria or proteinuria does not itself predict response to treatment or prognosis.
A glomerular disorder is usually suspected when screening or diagnostic testing reveals an elevated serum creatinine level and abnormal urinalysis (hematuria with or without casts, proteinuria, or both). Approach to the patient involves distinguishing predominant-nephritic from predominant-nephrotic features and identifying likely causes by patient age, accompanying illness (see Table 1: Glomerular Disorders: Glomerular Disorders by Age and Presentation and Table 4: Glomerular Disorders: Causes of Nephrotic Syndrome), and other elements of the history (eg, time course, systemic manifestations, family history).
Renal biopsy is indicated when diagnosis is unclear from history or when histology influences choice of treatment and outcomes (eg, lupus nephritis).
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Table 1
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| Glomerular Disorders by Age and Presentation |
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Age (yr)
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Nephritic Syndrome
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Nephrotic Syndrome
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Mixed Nephritic and Nephrotic Syndrome
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< 15
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Mild PIGN
IgA nephropathy
Thin basement membrane disease
Hereditary nephritis
Henoch-Schönlein purpura
Lupus nephritis
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Congenital nephrotic syndromes
Minimal change disease
Focal segmental glomerulosclerosis
Lupus (membranous nephropathy)
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Lupus nephritis
Membranoproliferative GN
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15–40
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IgA nephropathy
Thin basement membrane disease
Lupus nephritis
Hereditary nephritis
RPGN
PIGN
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Focal segmental glomerulosclerosis
Lupus nephritis
Minimal change disease
Membranous nephropathy
Diabetic nephropathy
Preeclampsia
Late PIGN
IgA nephropathy
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Membranoproliferative GN
Fibrillary and immunotactoid GN*
IgA nephropathy
Lupus nephritis
RPGN
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> 40
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IgA nephropathy
RPGN
Vasculitides
PIGN
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Focal segmental glomerulosclerosis
Membranous nephropathy
Diabetic nephropathy
Minimal change disease
IgA nephropathy
Amyloidosis (primary)
Light chain deposition disease
Benign nephrosclerosis
Late PIGN
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IgA nephropathy
Fibrillary and immunotactoid GN*
RPGN
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*More commonly manifests as nephrotic syndrome.
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GN = glomerulonephritis; PIGN = postinfectious glomerulonephritis; RPGN = rapidly progressive glomerulonephritis.
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Adapted from Rose BD: Pathophysiology of Renal Disease, ed. 2. New York, McGraw-Hill, 1987, p. 167.
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Last full review/revision January 2010 by James I. McMillan, MD
Content last modified January 2010
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